Comparative Cost-Effectiveness Analysis of Two Different Two-Dose Human Papillomavirus Vaccines in Malaysia

Abstract

Purpose: To comparatively evaluate the results of a 2-dose human papillomavirus (HPV) vaccination programme<br />with the AS04-adjuvanted HPV16/18 vaccine (AS04-HPV-16/18v) or HPV-6/11/16/18 vaccine (4vHPVv), in addition<br />to cervical cancer (CC) screening, in Malaysia. Methods: A lifetime Markov model replicating the natural history of<br />HPV in 13-year-old girls was adapted to Malaysia to assess the impact of vaccination on pre-cancerous lesions, genital<br />warts and CC cases, CC deaths, quality-adjusted life years (QALYs), and costs from the perspective of the Malaysian<br />Ministry of Health. Vaccine effectiveness was based on efficacy and HPV type distribution. Both vaccines were assumed<br />to have equal efficacy against vaccine-type HPV but differed for protection against non-vaccine types. Vaccine price<br />parity was used and health and cost outcomes were discounted at 3%/annum. Sensitivity analyses tested the robustness<br />of the results. Results: The model predicted that AS04-HPV-16/18v would result in 361 fewer CC cases and 115 fewer<br />CC deaths than 4vHPVv, whereas 4vHPVv averted 4,241 cases of genital warts over the cohort's lifetime. Discounted<br />total costs showed savings of 18.50 million Malaysian Ringgits and 246 QALYs in favour of AS04-HPV-16/18v. In<br />one-way sensitivity analyses, the discount rate was the most influential variable for costs and QALYs, but AS04-HPV-<br />16/18v remained dominant throughout. A two-way sensitivity analysis to assess the longevity of cross-protection for both<br />vaccines confirmed the base-case. Conclusions: In Malaysia, the use of AS04-HPV-16/18v, in addition to screening,<br />was modelled to be dominant over 4vHPVv, with greater estimated CC benefits and lower costs.